ACDIS Online: CDI Symposium for Outpatient Efforts

CDI’s role in the outpatient setting has not traditionally included evaluation and management (E/M), but with the increased volume of outpatient denials, E/M leveling and professional billing regulation can no longer be siloed. Collaboration between CDI, professional coders, HIM, and the revenue cycle team is essential in reducing denials. This team approach can uncover:

Root causes for denials

Gaps in documentation

Educational opportunities for providers

Follow up with progress

This session will examine how collaborative denial prevention promotes accurate claim submission that will result in lower account receivable days and allow for proper payment for services provided.

Ochsner’s outpatient CDI program is one of the earliest in the country and this session will discuss the highs and lows of getting the program off the ground and where the program is headed in the future. The speakers will cover opportunities for record review, how they educate providers about documentation improvement opportunities related to their medical records, and how they made the case to hospital administrators for CDI program expansion into the outpatient arena and will touch on common problems and strategies for overcoming them.

Many health systems are increasing the financial and quality impact of their CDI programs by expanding into outpatient and ambulatory, but CDI in these settings is challenging because it cannot simply replicate inpatient processes. During this session, the speakers will discuss critical success factors and program framework to leverage while developing an ambulatory CDI program—with an emphasis on clinical risk adjustment—while reviewing case studies that have achieved outsized impacts. It will cover compliance and vulnerabilities that exist in Medicare Advantage, including high-risk and mis-keyed diagnoses as well as OIG targeted audits across the industry.

Join Kenzi Brooks for a look at compliant querying in the outpatient setting and how West Virginia Medicine created a process for writing and communicating compliant queries. Brooks will discuss the difficulties in getting queries to healthcare professionals in the outpatient setting, along with how West Virginia Medical is now able to communicate with providers and track their responses to queries.

4:20 p.m. – 4:50 p.m. Join the speakers for a live Q&A and submit all your questions from the day’s sessions.

This case study presentation will walk you through scenarios and share best practices for documenting and coding for chronic conditions. Coding Guidelines state that a condition must be present at the time of the encounter, affect patient care or management, and be clearly documented to be coded as a diagnosis. Physicians must accurately document each patient diagnosis and the diagnosis MUST be based on clinical medical record documentation from a face-to-face encounter. This means that diagnoses cannot be wholly determined from test results and a patient’s past medical history. A well-documented progress note should include the HPI, ROS, physical exam, and show the medical decision-making process. Poland covers how each diagnosis must be documented in an assessment and care plan and each diagnosis must show that the provider is Monitoring, Evaluating, Assessing/Addressing, or Treating the condition.

Listen to takeaways from a physician advisor regarding streamlining processes to grow your outpatient CDI program. Find out how Baylor Scott & White Healthcare System uses physician advisors to bridge gaps between various departments and committees in order to develop best practice recommendations for documentation, and the biggest lessons they learned during the process of creating education for key conditions including MIs, malnutrition, pressure injuries, and diabetes.

Launching a successful documentation improvement initiative within an emergency department has its challenges, but also many rewards. CDI specialists are being tasked with obtaining clear and accurate documentation in the outpatient arena, including the emergency department. However, CDI programs in the outpatient settings carry a unique set of challenges for the CDI specialists, case managers, and physicians involved. This presentation will review how to build a program, areas of focus, education for CDIs and providers, and key program metrics, as well as overcoming obstacles.

Join the speakers for a live Q&A and submit all your questions from the day’s sessions.